Extracorporeal liver support systems in patients with acute-on-chronic liver failure: An updated systematic review and meta-analysis

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2024-11-22 DOI:10.1111/aor.14915

Haiyu Liu, Zhibo Yang, Qiong Luo, Jianhui Lin

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Abstract

Background

The utilization of extracorporeal liver support systems is increasingly prevalent for the management of acute-on-chronic liver failure in clinical settings. Yet, the efficacy of these interventions in terms of tangible clinical benefits for patients remains a matter of debate, underscoring the need for meta-analysis.

Methods

An updated meta-analysis was performed to elucidate the relationship between the application of extracorporeal liver support versus standard pharmacological treatment and the prognostic endpoints of patient survival, specifically assessing 1-month and 3-month mortality rates, as well as the incidence of complications such as hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. Literature were searched via PubMed, EMBASE, and Web of Science.

Results

The meta-analysis revealed the following: the odds ratio for 1-month mortality was 0.63 (95% confidence interval [CIs]: 0.51–0.76), for 3-month mortality was 0.70 (95% CI: 0.61–0.81), for hepatic encephalopathy was 0.81 (95% CI: 0.67–0.97), for spontaneous bacterial peritonitis was 0.66 (95% CI: 0.44–0.99), and for hepatorenal syndrome was 0.68 (95% CI: 0.51–0.92). These results suggest that patients with acute-on-chronic liver failure undergoing extracorporeal liver support system therapy have significantly better survival rates and lower complication incidences compared to those receiving conventional drug therapy. Further subgroup analysis indicated that patients with lower model for end-stage liver disease (MELD) scores and reduced total bilirubin (Tbil) levels demonstrated greater benefits from extracorporeal hepatic support.

Conclusion

This study establishes that in the management of acute-on-chronic liver failure, extracorporeal liver support systems confer a survival advantage and reduce complications relative to standard pharmacotherapy.

Abstract Image

查看原文本刊更多论文

急性-慢性肝衰竭患者的体外肝脏支持系统：最新系统综述和荟萃分析。

背景：体外肝脏支持系统在临床治疗急性-慢性肝衰竭中的应用越来越普遍。然而，这些干预措施是否能为患者带来切实的临床疗效仍存在争议，这凸显了进行荟萃分析的必要性：方法：我们进行了一项最新的荟萃分析，以阐明应用体外肝脏支持与标准药物治疗之间的关系，以及患者生存的预后终点，特别是评估 1 个月和 3 个月的死亡率，以及肝性脑病、自发性细菌性腹膜炎和肝肾综合征等并发症的发生率。通过 PubMed、EMBASE 和 Web of Science 对文献进行了检索：81），肝性脑病为 0.81（95% CI：0.67-0.97），自发性细菌性腹膜炎为 0.66（95% CI：0.44-0.99），肝肾综合征为 0.68（95% CI：0.51-0.92）。这些结果表明，与接受传统药物治疗的患者相比，接受体外肝脏支持系统治疗的急性-慢性肝衰竭患者的生存率明显更高，并发症发生率也更低。进一步的亚组分析表明，终末期肝病模型（MELD）评分较低、总胆红素（Tbil）水平较低的患者从体外肝支持治疗中获益更大：这项研究证实，在急性-慢性肝衰竭的治疗中，体外肝脏支持系统与标准药物治疗相比具有生存优势，并能减少并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.